Apply steady downward traction to the forearm while maintaining flexion of the elbow. 2016 Mar-Apr. We do not control or have responsibility for the content of any third-party site. We present our results with six patients with prosthetic posterior hip dislocation treated in our rural ED. If the initial approach does not reduce the dislocation, consider using a traction-countertraction technique with the patient supine. A traction-countertraction technique is recommended to reduce a posterior elbow dislocation. Posterior dislocation of the elbow Reduction should be attempted soon (eg, within 30 minutes) after the diagnosis is made. Leverage rather than forceful strength is the prerequisite. When this happens, the radius and ulna can diverge from each other. Reed MW, Reed DN. person reduction technique was also used to reduce 2 el-bows, 1 pediatric, that were unsuccessfully reduced using the traditional traction tech-nique. The elbow is one of the most commonly dislocated joints in the body, with an average annual incidence of acute dislocation of 6 per 100,000 persons. Nerve injury (median and ulnar nerves) is uncommon and can be due to local swelling, entrapment, or traction during the reduction. A traction-countertraction technique is recommended to reduce a posterior elbow dislocation. Do not use a circumferential cast. Most importantly, operators should be familiar with several techniques and use those appropriate to the patient's dislocation and clinical status (see Anterior Shoulder Dislocations: Treatment). Materials and personnel required for procedural sedation and analgesia (PSA), Intra-articular anesthetic (eg, 5 mL of 2% lidocaine, 10-mL syringe, 2-inch 20-gauge needle), antiseptic solution (eg, chlorhexidine, povidone iodine), gauze pads. Associated ligamentous injuries (lateral and medial ulnar collateral ligaments) are common with elbow dislocations and can simulate clinical findings of posterior elbow dislocations; therefore, pre- and post-procedure x-rays are recommended. Occasionally, the proximal radioulnar joint is disrupted. Elbow dislocations constitute 10% to 25% of all injuries to the elbow. We recorded patient demographics. FIGURE 65.3 Technique for reduction of posterior dislocation of the elbow. Intra-articular analgesia may be given in addition (eg, beforehand), to permit lower PSA dosing. Place the patient prone on the stretcher with the elbow flexed and the forearm dangling over the edge of the stretcher. Rarely, the radius and ulna translocate, with the radius medial a… Complicated dislocation (dislocation with associated fractures) or neurovascular compromise, because the procedure itself may increase injury severity. Elbow dislocations are described by the position of the proximal radioulnar joint relative to the distal humerus: Posterior, anterior, medial, or lateral. Assess the following: Distal pulses, capillary refill, and temperature (for coolness, suggesting brachial artery injury), Light touch sensation of the thenar and hypothenar eminences (median and ulnar nerves), and dorsum of the 1st web space (radial nerve), Wrist flexion and pronation, thumb-index finger apposition ("OK" gesture), and finger flexion against resistance (median nerve), Finger abduction against resistance (ulnar nerve), Wrist and finger extension against resistance (radial nerve). Alternative positioning: If the patient cannot lie prone, or if the prone position reduction attempt fails, do reduction with the patient supine or reclining. 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